1
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Sommerfeld LC, Holmes AP, Yu TY, O'Shea C, Kavanagh DM, Pike JM, Wright T, Syeda F, Aljehani A, Kew T, Cardoso VR, Kabir SN, Hepburn C, Menon PR, Broadway-Stringer S, O'Reilly M, Witten A, Fortmueller L, Lutz S, Kulle A, Gkoutos GV, Pavlovic D, Arlt W, Lavery GG, Steeds R, Gehmlich K, Stoll M, Kirchhof P, Fabritz L. Reduced plakoglobin increases the risk of sodium current defects and atrial conduction abnormalities in response to androgenic anabolic steroid abuse. J Physiol 2024. [PMID: 38345865 DOI: 10.1113/jp284597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
Androgenic anabolic steroids (AAS) are commonly abused by young men. Male sex and increased AAS levels are associated with earlier and more severe manifestation of common cardiac conditions, such as atrial fibrillation, and rare ones, such as arrhythmogenic right ventricular cardiomyopathy (ARVC). Clinical observations suggest a potential atrial involvement in ARVC. Arrhythmogenic right ventricular cardiomyopathy is caused by desmosomal gene defects, including reduced plakoglobin expression. Here, we analysed clinical records from 146 ARVC patients to identify that ARVC is more common in males than females. Patients with ARVC also had an increased incidence of atrial arrhythmias and P wave changes. To study desmosomal vulnerability and the effects of AAS on the atria, young adult male mice, heterozygously deficient for plakoglobin (Plako+/- ), and wild type (WT) littermates were chronically exposed to 5α-dihydrotestosterone (DHT) or placebo. The DHT increased atrial expression of pro-hypertrophic, fibrotic and inflammatory transcripts. In mice with reduced plakoglobin, DHT exaggerated P wave abnormalities, atrial conduction slowing, sodium current depletion, action potential amplitude reduction and the fall in action potential depolarization rate. Super-resolution microscopy revealed a decrease in NaV 1.5 membrane clustering in Plako+/- atrial cardiomyocytes after DHT exposure. In summary, AAS combined with plakoglobin deficiency cause pathological atrial electrical remodelling in young male hearts. Male sex is likely to increase the risk of atrial arrhythmia, particularly in those with desmosomal gene variants. This risk is likely to be exaggerated further by AAS use. KEY POINTS: Androgenic male sex hormones, such as testosterone, might increase the risk of atrial fibrillation in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), which is often caused by desmosomal gene defects (e.g. reduced plakoglobin expression). In this study, we observed a significantly higher proportion of males who had ARVC compared with females, and atrial arrhythmias and P wave changes represented a common observation in advanced ARVC stages. In mice with reduced plakoglobin expression, chronic administration of 5α-dihydrotestosterone led to P wave abnormalities, atrial conduction slowing, sodium current depletion and a decrease in membrane-localized NaV 1.5 clusters. 5α-Dihydrotestosterone, therefore, represents a stimulus aggravating the pro-arrhythmic phenotype in carriers of desmosomal mutations and can affect atrial electrical function.
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Affiliation(s)
- Laura C Sommerfeld
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- University Center of Cardiovascular Science, University Heart and Vascular Center, UKE Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Standort Hamburg/Kiel/Lübeck, Germany
| | - Andrew P Holmes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- School of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Ting Y Yu
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Research and Training Centre in Physical Sciences for Health, Birmingham, UK
| | - Christopher O'Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Research and Training Centre in Physical Sciences for Health, Birmingham, UK
| | - Deirdre M Kavanagh
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Centre of Membrane Proteins and Receptors (COMPARE), University of Birmingham, Birmingham, UK
| | - Jeremy M Pike
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Centre of Membrane Proteins and Receptors (COMPARE), University of Birmingham, Birmingham, UK
| | - Thomas Wright
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Fahima Syeda
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Areej Aljehani
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Tania Kew
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Victor R Cardoso
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - S Nashitha Kabir
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Claire Hepburn
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Priyanka R Menon
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Molly O'Reilly
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Anika Witten
- Genetic Epidemiology, Institute for Human Genetics, University of Münster, Münster, Germany
- Core Facility Genomics of the Medical Faculty, University of Münster, Münster, Germany
| | - Lisa Fortmueller
- University Center of Cardiovascular Science, University Heart and Vascular Center, UKE Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Standort Hamburg/Kiel/Lübeck, Germany
- Genetic Epidemiology, Institute for Human Genetics, University of Münster, Münster, Germany
| | - Susanne Lutz
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexandra Kulle
- Division of Paediatric Endocrinology and Diabetes, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Georgios V Gkoutos
- University Center of Cardiovascular Science, University Heart and Vascular Center, UKE Hamburg, Hamburg, Germany
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- MRC Health Data Research UK (HDR), Midlands Site, UK
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
- Medical Research Council London Institute of Medical Sciences, London UK & Institute of Clinical Sciences, Faculty of Medicine, Imperial College, London, UK
| | - Gareth G Lavery
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
| | - Richard Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Katja Gehmlich
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Monika Stoll
- Genetic Epidemiology, Institute for Human Genetics, University of Münster, Münster, Germany
- Core Facility Genomics of the Medical Faculty, University of Münster, Münster, Germany
- Cardiovascular Research Institute Maastricht, Department of Biochemistry, Maastricht University, Maastricht, The Netherlands
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- German Center for Cardiovascular Research (DZHK), Standort Hamburg/Kiel/Lübeck, Germany
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- University Center of Cardiovascular Science, University Heart and Vascular Center, UKE Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Standort Hamburg/Kiel/Lübeck, Germany
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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2
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Zado ES, Garg L, Tschabrunn C, Santangeli P, Hyman M, Kumareswaran R, Arkles J, Marchlinski FE. Risk of atrial arrhythmias in patients with ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2024; 21:133-140. [PMID: 37956774 DOI: 10.1016/j.hrthm.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND In arrhythmogenic right ventricular cardiomyopathy (ARVC), risk of atrial arrhythmias (AAs) persists after ventricular tachycardia (VT) ablation. OBJECTIVE The purpose of this study was to determine the type, prevalence, outcome, and risk correlates of AA in ARVC in patients undergoing VT ablation. METHODS Prospectively collected procedural and clinical data on ARVC patients undergoing VT ablation were analyzed. Risk score for typical atrial flutter was determined from univariate logistic regression analysis. RESULTS Of 119 consecutive patients with ARVC and VT ablation, 40 (34%) had AA: atrial fibrillation (AF) in 31, typical isthmus-dependent atrial flutter (AFL) in 27, and atrial tachycardia/atypical flutter (AT) in 10. Seventeen patients (43%) with AA experienced inappropriate defibrillator therapy, with 15 patients experiencing shocks. Ablation was performed for typical AFL in 21 (53%), AT in 5 (13%), and pulmonary vein isolation for AF in 4 (10%) patients and prevented AA in 78% and all AFL during additional mean follow-up of 65 months. Risk score for typical flutter included age >40 years (1 point), ≥moderate right ventricular dysfunction (2 points), ≥moderate tricuspid regurgitation (2 points), ≥moderate right atrial dilation (2 points), and right ventricular volume >250 cc (3points), with score >4 identifying 50% prevalence of typical flutter. CONCLUSION AAs are common in patients with ARVC and VT, can result in inappropriate implantable cardioverter-defibrillator shocks, and typically are controlled with atrial ablation. A risk score can be used to identify patients at high risk for typical AFL who may be considered for isthmus ablation at the time of VT ablation.
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Affiliation(s)
- Erica S Zado
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lohit Garg
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cory Tschabrunn
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Hyman
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Arkles
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Toso E, De Lio F, Bocchino PP, Raineri C, Fioravanti F, Richiardi EM, Marcelli G, Sacco T, Giustetto C, Gaita F. Risk of cardioembolic ischemic events and relation to atrial fibrillation/flutter in patients with arrhythmogenic cardiomyopathy during a long-term follow-up. Int J Cardiol 2023; 389:131200. [PMID: 37482095 DOI: 10.1016/j.ijcard.2023.131200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is an inherited heart disease characterized by fibro-fatty replacement of myocardium. Limited data is available concerning cardioembolic stroke. This study sought to determine the occurrence of cardioembolic ischemic events (CIEs) in ACM patients and to identify clinical and imaging predictors of CIEs. METHODS Every consecutive ACM patient was enrolled. ECG, Holter monitoring or implantable cardiac devices were used to detect atrial arrhythmias (AAs). CIEs were defined according to TOAST classification. RESULTS In our cohort of 111 patients, CIEs were observed in eleven (10%) over a 12.9-year median follow-up, with an incidence of 7.9 event/1000 patient-year (HR 4.12 compared to general population). Mean age at the event was 42 ± 9 years. Female sex (p = 0.03), T-wave inversion (p = 0.03), RVOT dilatation (p = 0.006) and lower LVEF (p = 0.006) were associated with CIEs. Among patients with AAs (23/111, 20.7%), 5 (21.7%) experienced CIEs. CHA2DS2-VASc did not prove useful to define patients at higher risk of CIEs (p = 0.098). 60% of stroke suffering patients had a pre-event score between 0 and 1 (if female). CONCLUSIONS In ACM patients, CIEs are much more common than in general population and present a high burden at younger age. AAs relate to less than half of these events. In AAs patients, CHA2DS2-VASc is not useful to stratify those requiring oral anticoagulation. As a hypothesis-generating study, our research proposes the role of atrial myopathy, irrespective of AAs, as a pivotal factor in thrombogenesis risk, pointing out a definite unmet need in ACM therapeutic algorithm.
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Affiliation(s)
- Elisabetta Toso
- Advanced Cardiovascular Echography Unit, "Città della Salute e della Scienza" Hospital, Turin, Italy.
| | - Francesca De Lio
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy.
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Claudia Raineri
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | | | - Elena Maria Richiardi
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Gianluca Marcelli
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Tania Sacco
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy.
| | - Fiorenzo Gaita
- Department of Medical Sciences, University of Turin, Turin, Italy
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:970-978. [DOI: 10.1093/ehjci/jeac070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
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Cainap SS, Kovalenko I, Bonamano E, Crousen N, Tirpe A, Cismaru A, Iacob D, Lazea C, Negru A, Cismaru G. Anatomical-MRI Correlations in Adults and Children with Arrhythmogenic Right Ventricular Cardiomyopathy. Diagnostics (Basel) 2021; 11:diagnostics11081388. [PMID: 34441321 PMCID: PMC8392323 DOI: 10.3390/diagnostics11081388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/04/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare disease in which the right ventricular myocardium is replaced by islands of fibro-adipose tissue. Therefore, ventricular re-entry circuits can occur, predisposing the patient to ventricular tachyarrhythmias, as well as dilation of the right ventricle that eventually leads to heart failure. Although it is a rare disease with low prevalence in Europe and the United States, many patients are addressed disproportionately for cardiac magnetic resonance imaging (MRI). The most severe consequence of this condition is sudden cardiac death at a young age due to untreated cardiac arrhythmias. The purpose of this paper is to revise the magnetic resonance characteristics of ARVC, including the segmental contraction abnormalities, fatty tissue replacement, decrease of the ejection fraction, and the global RV dilation. Herein, we also present several recent improvements of the 2010 Task Force criteria that are not included within the ARVC diagnosis guidelines. In our opinion, these features will be considered in a future Task Force Consensus.
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Affiliation(s)
- Simona-Sorana Cainap
- 2nd Pediatric Discipline, Mother and Child Department, Emergency Clinical Hospital for Children, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Ilana Kovalenko
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Edoardo Bonamano
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Niclas Crousen
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Alexandru Tirpe
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Andrei Cismaru
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania;
| | - Daniela Iacob
- 3rd Pediatric Discipline, Mother and Child Department, Emergency Clinical Hospital for Children, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Cecilia Lazea
- 1st Pediatric Discipline, Mother and Child Department, Emergency Clinical Hospital for Children, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Alina Negru
- Department of Cardiology, ‘Victor Babeș’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-721926230
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6
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Yeung C, Enriquez A, Suarez-Fuster L, Baranchuk A. Atrial fibrillation in patients with inherited cardiomyopathies. Europace 2020; 21:22-32. [PMID: 29684120 DOI: 10.1093/europace/euy064] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) often complicates the course of inherited cardiomyopathies and, in some cases, may be the presenting feature. Each inherited cardiomyopathy has its own peculiar pathogenetic characteristics that can contribute to the development and maintenance of AF. Atrial fibrillation may occur as a consequence of disease-specific defects, non-specific cardiac chamber changes secondary to the primary illness, or a combination thereof. The presence of AF can denote a turning point in the progression of the disease, promoting clinical deterioration and increasing morbidity and mortality. Furthermore, the management of AF can be particularly challenging in patients with inherited cardiomyopathies. In this article, we review the current information on the prevalence, pathophysiology, risk factors, and treatment of AF in three different inherited cardiomyopathies: hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia/cardiomyopathy, familial dilated cardiomyopathy, and left ventricular non-compaction cardiomyopathy.
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Affiliation(s)
- Cynthia Yeung
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Andres Enriquez
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | | | - Adrian Baranchuk
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
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7
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Rujirachun P, Wattanachayakul P, Charoenngam N, Winijkul A, Ungprasert P. Prevalence of atrial arrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 21:368-376. [PMID: 32243340 DOI: 10.2459/jcm.0000000000000962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND/OBJECTIVES Little is known about atrial involvement in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Recent studies have suggested that atrial arrhythmia, including atrial fibrillation, atrial flutter (AFL), and atrial tachycardia, was common among these patients although the reported prevalence varied considerably across the studies. The current systematic review and meta-analysis was conducted with the aim of comprehensively investigating the prevalence of overall atrial arrhythmia and each atrial arrhythmia subtype in the setting of ARVC by identifying all relevant studies and combining their results together. METHODS A comprehensive literature review was conducted by searching for published articles indexed in MEDLINE and EMBASE databases from inception through to 22 September 2019 to identify cohort studies of patients with ARVC that described the prevalence of atrial arrhythmia among the participants. The pooled prevalence across studies was calculated using a random-effect, generic inverse variance method of DerSimonian and Laird with a double arcsine transformation. RESULTS A total of 16 cohort studies with 1986 patients with ARVC were included in this meta-analysis. The pooled prevalence of overall atrial arrhythmia among patients with ARVC was 17.9% [95% confidence interval (CI), 13.0-24.0%; I 88%], the pooled prevalence of atrial fibrillation of 12.9% (95% CI, 9.6-17.0%; I 78%), the pooled prevalence of AFL of 5.9% (95% CI, 3.7-9.2%; I 70%), and the pooled prevalence of atrial tachycardia of 7.1% (95% CI, 3.7-13.0%; I 49%). CONCLUSION Atrial arrhythmia is common among patients with ARVC with the pooled prevalence of approximately 18%, which is substantially higher than the reported prevalence of atrial arrhythmia in the general population.
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Affiliation(s)
| | | | | | | | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Cardona‐Guarache R, Åström‐Aneq M, Oesterle A, Asirvatham R, Svetlichnaya J, Marcus GM, Gerstenfeld EP, Klein L, Scheinman MM. Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: Prevalence, echocardiographic predictors, and treatment. J Cardiovasc Electrophysiol 2019; 30:1801-1810. [DOI: 10.1111/jce.14069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/04/2019] [Accepted: 06/27/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Ricardo Cardona‐Guarache
- Division of CardiologyDepartment of MedicineUniversity of California San FranciscoSan Francisco California
| | - Meriam Åström‐Aneq
- Division of Clinical PhysiologyDepartment of MedicineLinköping UniversityLinköping Sweden
| | - Adam Oesterle
- Division of CardiologyDepartment of MedicineUniversity of California San FranciscoSan Francisco California
| | - Roshini Asirvatham
- Division of CardiologyDepartment of MedicineUniversity of California San FranciscoSan Francisco California
| | - Jana Svetlichnaya
- Division of CardiologyDepartment of MedicineKaiser PermanenteSan Francisco California
| | - Gregory M. Marcus
- Division of CardiologyDepartment of MedicineUniversity of California San FranciscoSan Francisco California
| | - Edward P. Gerstenfeld
- Division of CardiologyDepartment of MedicineUniversity of California San FranciscoSan Francisco California
| | - Liviu Klein
- Division of CardiologyDepartment of MedicineUniversity of California San FranciscoSan Francisco California
| | - Melvin M. Scheinman
- Division of CardiologyDepartment of MedicineUniversity of California San FranciscoSan Francisco California
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Marcinkevics R, O'Neill J, Law H, Pervolaraki E, Hogarth A, Russell C, Stegemann B, Holden AV, Tayebjee MH. Multichannel electrocardiogram diagnostics for the diagnosis of arrhythmogenic right ventricular dysplasia. Europace 2019; 20:f13-f19. [PMID: 29016773 DOI: 10.1093/europace/eux124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/12/2017] [Indexed: 11/14/2022] Open
Abstract
Aims The identification of arrhythmogenic right ventricular dysplasia (ARVD) from 12-channel standard electrocardiogram (ECG) is challenging. High density ECG data may identify lead locations and criteria with a higher sensitivity. Methods and results Eighty-channel ECG recording from patients diagnosed with ARVD and controls were quantified by magnitude and integral measures of QRS and T waves and by a measure (the average silhouette width) of differences in the shapes of the normalized ECG cycles. The channels with the best separability between ARVD patients and controls were near the right ventricular wall, at the third intercostal space. These channels showed pronounced differences in P waves compared to controls as well as the expected differences in QRS and T waves. Conclusion Multichannel recordings, as in body surface mapping, add little to the reliability of diagnosing ARVD from ECGs. However, repositioning ECG electrodes to a high anterior position can improve the identification of ECG variations in ARVD. Additionally, increased P wave amplitude appears to be associated with ARVD.
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Affiliation(s)
| | - James O'Neill
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
| | - Hannah Law
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
| | | | - Andrew Hogarth
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
| | - Craig Russell
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
| | | | - Arun V Holden
- School of Biomedical Sciences, University of Leeds, Leeds LS2?9JT, UK
| | - Muzahir H Tayebjee
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
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10
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Zghaib T, Bourfiss M, van der Heijden JF, Loh P, Hauer RN, Tandri H, Calkins H, Nazarian S, te Riele AS, Zimmerman SL, Velthuis BK. Atrial Dysfunction in Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Cardiovasc Imaging 2018; 11:e007344. [DOI: 10.1161/circimaging.117.007344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Tarek Zghaib
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., H.T., H.C.)
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, The Netherlands (M.B., J.F.v.d.H., P.L., R.N.H., A.S.J.M.t.R.)
| | - Jeroen F. van der Heijden
- Department of Cardiology, University Medical Center Utrecht, The Netherlands (M.B., J.F.v.d.H., P.L., R.N.H., A.S.J.M.t.R.)
| | - Peter Loh
- Department of Cardiology, University Medical Center Utrecht, The Netherlands (M.B., J.F.v.d.H., P.L., R.N.H., A.S.J.M.t.R.)
| | - Richard N. Hauer
- Department of Cardiology, University Medical Center Utrecht, The Netherlands (M.B., J.F.v.d.H., P.L., R.N.H., A.S.J.M.t.R.)
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., H.T., H.C.)
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., H.T., H.C.)
| | - Saman Nazarian
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.)
| | - Anneline S.J.M. te Riele
- Department of Cardiology, University Medical Center Utrecht, The Netherlands (M.B., J.F.v.d.H., P.L., R.N.H., A.S.J.M.t.R.)
| | - Stefan L. Zimmerman
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (S.L.Z.)
| | - Birgitta K. Velthuis
- Department of Radiology, University Medical Center Utrecht, The Netherlands (B.K.V.)
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Nunes de Alencar Neto J, Baranchuk A, Bayés-Genís A, Bayés de Luna A. Arrhythmogenic right ventricular dysplasia/cardiomyopathy: an electrocardiogram-based review. Europace 2017; 20:f3-f12. [DOI: 10.1093/europace/eux202] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- José Nunes de Alencar Neto
- Department of Cardiology, Hospital de Sao Paulo, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP: 04024002, Sao Paulo, Brasil
| | - Adrian Baranchuk
- Cardiac Electrophysiology and Pacing, Kingston General Hospital K7L 2V7, Queen's University, Kingston, Ontario, Canada
| | - Antoni Bayés-Genís
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Antoni Bayés de Luna
- Cardio Vascular Research Center, Catalan Institute of Cardiovascular Sciences, St. Pau Hospital, C/Sant Antoni Ma Claret, 167, 08025 Barcelona, Spain
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Müssigbrodt A, Knopp H, Efimova E, Weber A, Bertagnolli L, Hilbert S, Kosiuk J, Dinov B, Bode K, Kircher S, Dagres N, Richter S, Sommer P, Husser D, Bollmann A, Hindricks G, Arya A. Supraventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy associate with long-term outcome after catheter ablation of ventricular tachycardias. Europace 2017; 20:1182-1187. [DOI: 10.1093/europace/eux179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/01/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andreas Müssigbrodt
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Helge Knopp
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Elena Efimova
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Alexander Weber
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Jedrzej Kosiuk
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Kerstin Bode
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Simon Kircher
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Daniela Husser
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, University of Leipzig, HELIOS Heart Centre, Strümpellstrasse 39, Leipzig, Germany
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BOURFISS MIMOUNT, TE RIELE ANNELINES, MAST THOMASP, CRAMER MAARTENJ, VAN DER HEIJDEN JEROENF, VAN VEEN TOONA, LOH PETER, DOOIJES DENNIS, HAUER RICHARDN, VELTHUIS BIRGITTAK. Influence of Genotype on Structural Atrial Abnormalities and Atrial Fibrillation or Flutter in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. J Cardiovasc Electrophysiol 2016; 27:1420-1428. [DOI: 10.1111/jce.13094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 08/14/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- MIMOUNT BOURFISS
- Faculty of Medicine (M.D. Program); University of Utrecht; Utrecht the Netherlands
| | | | - THOMAS P. MAST
- Department of Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - MAARTEN J. CRAMER
- Department of Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - TOON A.B. VAN VEEN
- Department of Medical Physiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - PETER LOH
- Department of Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - DENNIS DOOIJES
- Department of Medical Genetics; University Medical Center Utrecht; Utrecht the Netherlands
| | - RICHARD N.W. HAUER
- Department of Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
- Netherlands Heart Institute; University Medical Center Utrecht; Utrecht the Netherlands
| | - BIRGITTA K. VELTHUIS
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
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14
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Atrial Remodeling and Atrial Tachyarrhythmias in Arrhythmogenic Right Ventricular Cardiomyopathy. Am J Cardiol 2016; 118:750-3. [PMID: 27378141 DOI: 10.1016/j.amjcard.2016.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 11/22/2022]
Abstract
Less is known about atrial remodeling and atrial tachyarrhythmias (ATa) in arrhythmogenic right ventricular cardiomyopathy (ARVC); this cross-sectional study aimed to determine the prevalence, characterization, and predictors of atrial remodeling and ATa in a large series of patients with ARVC. From February 2004 to September 2014, 294 consecutive patients who met the task force criteria for ARVC were enrolled. The prevalence, characterization, and predictors of atrial dilation and ATa were investigated. Right atrium (RA) dilation was identified in 160 patients (54.4%) and left atrium dilation in 66 patients (22.4%). Both RA and left atrium dilation were found in 44 patients (15.0%). Twenty-five patients (8.5%) had atrial fibrillation (AF), whereas 19 patients (6.5%) had atrial flutter (AFL). Of which, 7 patients (2.4%) had both AF and AFL. Multivariate analysis showed that AFL (odds ratio [OR] 10.309; 95% confidence interval [CI] 2.770 to 38.462; p <0.001), hypertension (OR 9.174; 95% CI 2.364 to 35.714; p = 0.001), and RA dilation (OR 6.993; 95% CI 1.623 to 30.303; p = 0.009) were associated with increased risk for AF. AF (OR 10.526; 95% CI 2.786 to 40.000; p = 0.001) increased the risk of AFL. In conclusion, atrial remodeling and ATa were common in patients with ARVC.
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Wilson D, Livesey S, Morgan J. Long-term follow-up of right ventricular disarticulation for treatment of Arrhythmogenic Right Ventricular Cardiomyopathy: a case series. Int J Cardiol 2014; 175:e21-4. [PMID: 24825028 DOI: 10.1016/j.ijcard.2014.04.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/22/2014] [Indexed: 11/26/2022]
Affiliation(s)
- David Wilson
- University Hospital of Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom.
| | - Steve Livesey
- University Hospital of Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - John Morgan
- University Hospital of Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
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16
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Saguner AM, Ganahl S, Kraus A, Baldinger SH, Medeiros-Domingo A, Saguner AR, Mueller-Burri SA, Wolber T, Haegeli LM, Krasniqi N, Tanner FC, Steffel J, Brunckhorst C, Duru F. Clinical Role of Atrial Arrhythmias in Patients With Arrhythmogenic Right Ventricular Dysplasia. Circ J 2014; 78:2854-61. [DOI: 10.1253/circj.cj-14-0474] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Sabrina Ganahl
- Department of Cardiology, University Heart Center Zurich
| | - Andrea Kraus
- Division of Biostatistics, Institute for Social and Preventive Medicine, University Zurich
| | | | - Argelia Medeiros-Domingo
- Department of Cardiology, University Heart Center Zurich
- Department of Cardiology, University Hospital Bern
| | | | | | - Thomas Wolber
- Department of Cardiology, University Heart Center Zurich
- Center for Integrative Human Physiology, University Zurich
| | | | - Nazmi Krasniqi
- Department of Cardiology, University Heart Center Zurich
| | - Felix C. Tanner
- Department of Cardiology, University Heart Center Zurich
- Center for Integrative Human Physiology, University Zurich
| | - Jan Steffel
- Department of Cardiology, University Heart Center Zurich
| | | | - Firat Duru
- Department of Cardiology, University Heart Center Zurich
- Center for Integrative Human Physiology, University Zurich
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17
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Arrhythmogenic right ventricular cardiomyopathy: Arrhythmias upstream and downstream. Heart Rhythm 2013; 10:1669-70. [DOI: 10.1016/j.hrthm.2013.09.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Indexed: 11/23/2022]
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18
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Camm CF, James CA, Tichnell C, Murray B, Bhonsale A, te Riele ASJM, Judge DP, Tandri H, Calkins H. Prevalence of atrial arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy. Heart Rhythm 2013; 10:1661-8. [PMID: 23994726 DOI: 10.1016/j.hrthm.2013.08.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited cardiomyopathy, characterized by right ventricular dysfunction and ventricular arrhythmias. Limited information is available concerning atrial arrhythmias in ARVD/C. OBJECTIVE The purpose of this study was to characterize spontaneous atrial arrhythmias in a large registry population of ARVD/C patients. METHODS Patients (n = 248) from the Johns Hopkins ARVD/C registry who met the diagnostic criteria and had undertaken genotype analysis were included. Medical records of each were reviewed to ascertain incidence and characteristics of atrial arrhythmia episodes. Detailed demographic, phenotypic, and structural information was obtained from registry data. RESULTS Thirty-five patients with ARVD/C (14%) experienced one or more types of atrial arrhythmia during median follow-up of 5.78 (interquartile range 8.52) years. Atrial fibrillation was the most common atrial arrhythmia, occurring in 80% of ARVD/C patients with atrial arrhythmias. Patients developed atrial arrhythmias at a mean age of 43.0 ± 14.0 years. Atrial arrhythmia patients obtained a total of 22 inappropriate implantable cardioverter-defibrillator shocks during follow-up. Older age at last follow-up (P <.001) and male gender (P = .044) were associated with atrial arrhythmia development. Patients with atrial arrhythmias had a higher occurrence of death (P = .028), heart failure (P <.001), and left atrial enlargement on echocardiography (P = .004). CONCLUSION Atrial arrhythmias are common in ARVD/C and present at a younger age than in the general population. They are associated with male gender, increasing age, and left atrial enlargement. Atrial arrhythmias are clinically important as they are associated with inappropriate implantable cardioverter-defibrillator shocks and increased risk of both death and heart failure.
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19
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Chu AF, Zado E, Marchlinski FE. Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and ventricular tachycardia. Am J Cardiol 2010; 106:720-2. [PMID: 20723652 DOI: 10.1016/j.amjcard.2010.04.031] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/07/2010] [Accepted: 04/07/2010] [Indexed: 11/30/2022]
Abstract
Information on atrial arrhythmia associated with right ventricular cardiomyopathy/dysplasia (ARVC/D) is limited. In 36 patients with task force criteria for ARVC/D and history of ventricular tachycardia (VT), we confirmed the incidence and type of atrial arrhythmia, onset related to referral for VT ablation, fastest documented ventricular rate, management, and clinical and hemodynamic factors associated with their development. Thirty-six patients (28 men) had a mean age of 47 years (range 17 to 80) and mean follow-up of 56 +/- 44 months. Thirty-five patients (97%) had implantable cardioverter-defibrillator (ICD) devices, 15 with atrial leads. Fifteen of 36 patients (42%) had documented atrial arrhythmias, with atrial flutter (aFL) in 11, atrial fibrillation (AF) in 11 patients, and aFL and AF in 7 patients. Maximum heart rate noted with atrial arrhythmia was 62 to 150 beats/min. In 9 patients, initial atrial arrhythmia preceded or was concurrent with presentation for VT ablation. In the remaining 6 patients, atrial arrhythmia (symptomatic in 4 patients) followed VT presentation. Three of these patients received ICD shock therapy for atrial arrhythmias. Seven of 11 patients with recurrent aFL required aFL ablation, 1 patient underwent His-bundle ablation for AF with rapid rate, and 8 patients required long-term drug therapy for AF control. Atrial arrhythmias were more common in patients with RV enlargement and moderate/severe tricuspid regurgitation. In conclusion, in patients with ARVC/D and VT, atrial arrhythmias are common, frequently necessitate ablative or pharmacologic treatment, and are more common in patients with moderate/severe tricuspid regurgitation and markedly enlarged right ventricle.
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Affiliation(s)
- Antony F Chu
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
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20
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HAMILTON ROBERTM. Arrhythmogenic Right Ventricular Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 2:S44-51. [DOI: 10.1111/j.1540-8159.2009.02384.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Brembilla-Perrot B, Beurrier D, Houriez P, Suty-Selton C, Nippert M, Claudon O, Andronache M, Ernst Y, Khaldi E, Belhakem H, Popovic B, Terrier de la Chaise A, Louis P. Electrophysiologic characteristics of atria in patients without heart disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 28:1066-72. [PMID: 16221265 DOI: 10.1111/j.1540-8159.2005.00240.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The significance of atrial fibrillation or tachycardia (AF) induction remains debatable. Some believe that the presence of heart disease (HD) increases the sensitivity and decreases the specificity of programmed atrial stimulation (PAS). There are few data in patients without HD. The purpose of the study was to evaluate the results of PAS in asymptomatic patients without HD and in those with documented spontaneous AF, but without HD, to know the diagnosis value of the technique. METHODS A total of 4,900 PAS were consecutively performed. The control group (I, N=67) was defined by the absence of preexcitation syndrome, dizziness/syncope, hypertension, history of tachycardia, or other documented HD together with a normal 2D echocardiogram and 24-hour Holter monitoring. They were compared to a group (II) of 54 patients with documented paroxysmal AF and without HD. PAS used one and two extrastimuli, delivered during sinus rhythm and two drive rates (600, 400 ms). Atrial-effective refractory periods (ARP), their adaptation to cycle length, and conduction times were noted. AF induction was defined as the induction of AF lasting more than 1 minute. RESULTS Group I patients (1.4% of 4,900) were younger than group II (51 +/- 17 vs 65 +/- 11 years, P < 0.001). A single extrastimulus never induced sustained AF in group I, but did so in 11 group II patients (20%); sustained AF was induced by two extrastimuli in 15 group I patients (22%) and in 31 group II patients (57%) (P < 0.001). There were no ARP and conduction time differences in group I patients with and without inducible AF, but there was a longer sinus cycle length in patients with inducible AF (977 +/- 164 vs 838 +/- 141 ms, P < 0.02). There were no electrophysiological differences in group II patients with and without inducible AF. No group I patient developed spontaneous AF (follow-up 4 +/- 2 years). The sensitivity of PAS with one extrastimulus was 20% and the specificity 100%; the sensitivity of PAS with two extrastimuli was 57% and the specificity 78%. CONCLUSION Sustained AF was not induced by one extrastimulus in control patients without symptoms, nor heart disease, but sustained AF was induced by two extrastimuli in 22% of these patients. The induction of a sustained AF by two extrastimuli should be interpreted cautiously, particularly in patients with a relative sinus bradycardia. However, the sensitivity of PAS with one extrastimulus was very low and two extrastimuli were required in patients with spontaneous AF to induce the tachycardia. Other electrophysiological parameters were not useful to differentiate patients with and without inducible AF.
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Lemola K, Brunckhorst C, Helfenstein U, Oechslin E, Jenni R, Duru F. Predictors of adverse outcome in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy: long term experience of a tertiary care centre. Heart 2005; 91:1167-72. [PMID: 16103549 PMCID: PMC1769099 DOI: 10.1136/hrt.2004.038620] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the predictors for adverse clinical outcome in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) during long term follow up. METHODS 61 patients with ARVD/C were studied to assess the impact of family history, clinical findings, surface ECG parameters, echocardiographic findings, and electrophysiological findings on clinical outcome. The prevalence of these risk factors were compared in two patient groups: group A (patients with adverse clinical outcome: sudden cardiac death, death from heart failure, or heart transplant) and group B (survivors excluding patients who received a heart transplant). RESULTS Mean age at first diagnosis was 44 (14) years. The mean follow up duration was 55 (47) months. Ten patients (16%) died during follow up. The cause of death of eight of these patients was probably arrhythmic. Two patients died of advanced heart failure. Five patients underwent heart transplantation because of terminal heart failure. Risk factors significantly associated with adverse outcome were history of congestive heart failure (p < 0.001), the presence of left ventricular involvement on echocardiography (p < 0.001), left atrial dilatation (p < 0.05), prolonged PR duration (p < 0.01), prolonged QRS in V1 (p < 0.05), and bundle branch block (p < 0.05). In multivariate analysis, history of congestive heart failure and presence of left ventricular involvement were identified as independent risk predictors for an adverse outcome. CONCLUSIONS Congestive heart failure and left ventricular involvement are independently associated with adverse outcome in patients with ARVD/C during long term follow up.
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Affiliation(s)
- K Lemola
- Division of Cardiology, Cardiovascular Centre, University Hospital of Zurich, Zurich, Switzerland
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Brembilla-Perrot B, Burger G, Beurrier D, Houriez P, Nippert M, Miljoen H, Andronache M, Khaldi E, Popovic B, De La Chaise AT, Louis P. Influence of age on atrial fibrillation inducibility. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:287-92. [PMID: 15009851 DOI: 10.1111/j.1540-8159.2004.00429.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The prevalence of AF is known to increase in the elderly. Some electrophysiological changes were reported in these patients, but the effects of age on AF inducibility and other electrophysiological signs associated with atrial vulnerability are unknown. The purpose of the study was to evaluate the effects of age on atrial vulnerability and AF induction. The study consisted of 734 patients (age 16-85 years, mean 61 +/- 15 years) without spontaneous AF who were admitted for electrophysiological study. Study was indicated for dizziness or ventricular tachyarrhythmia. Programmed atrial stimulation was systematically performed. One and two extrastimuli were delivered in sinus rhythm and atrial driven rhythms (600, 400 ms). Univariate and multivariate analysis of several clinical and electrophysiological data were performed. AF inducibility, defined as the induction of an AF lasting > 1 minute, was paradoxically and significantly decreased in elderly (> 70 years) patients compared to younger patients (< 70 years) (P < 0.01). AF inducibility was present in 40% of 62 patients < 40 years, 39% of 99 patients age 40-50 years, 37% of 130 patients age 50-60 years, 38% of 222 patients age 60-70 years, and only 28% of 221 patients > 70 years. There was no significant correlation with the sex, the presence of dizziness, the presence or not of an underlying heart disease, the left ventricular ejection fraction, and the presence of salvos of atrial premature beats on 24-hour Holter monitoring. There was a significant correlation with a longer atrial effective refractory period in the elderly (226 +/- 41 ms) than in younger patients (208 +/- 31 ms) (P < 0.001). Other electrophysiological parameters of atrial vulnerability did not change significantly. Increased atrial refractory period and age >70 years were independent factors of decreased AF inducibility. Programmed atrial stimulation should be interpreted cautiously before the age of 70 years. AF induction is facilitated by the presence of a short atrial refractory period in these patients. Surprisingly, AF inducibility decreases in patients > 70 years because their atrial refractory period increases. Therefore, increased AF prevalence in these patients should be explained by nonelectrophysiological causes.
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